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Judge Weighs In During Arguments of Multistate Lawsuit Against Reform

During a hearing on Thursday, U.S. District Court Judge Roger Vinson indicated that he agreed with plaintiffs in the multistate lawsuit against the federal health reform law that the overhaul's individual mandate is unconstitutional, the Wall Street Journal reports.

However, Vinson expressed skepticism regarding the plaintiffs' claim that the overhaul's expansion of the Medicaid program is illegal (Adamy, Wall Street Journal, 12/17).

The lawsuit was filed in March by Florida Attorney General Bill McCollum (R) with the support of 19 other mostly Republican state attorneys general and governors, and the National Federation of Independent Business. The states contend that they will be overwhelmed by the costs for the Medicaid expansion that is set to begin in 2014.

In October, Vinson denied the federal government's motion to dismiss the lawsuit and allowed plaintiffs to proceed with their complaints against the individual mandate and Medicaid expansion. Thursday's hearing was scheduled to allow lawyers for both sides to present oral arguments in the case (California Healthline, 12/16).

Arguments on Individual Mandate

During the three-hour hearing, lawyers for the states argued that the Obama administration was wrong to suggest that the individual mandate is an economic activity that justifies regulation by Congress, the New York Times reports.

Vinson agreed, saying that the mandate would constitute "a giant expansion" of the powers granted to Congress under the commerce clause in the Constitution (Sack, New York Times, 12/16).

He said, "In the broadest sense every decision we make is economic. The decision to marry. The decision to keep a job or not has an economic effect," adding, "If [the federal government] decided everybody needs to eat broccoli because broccoli makes us healthy, they could mandate that everybody has to eat broccoli each week?" (Aizenman, Washington Post, 12/17).

However, Department of Justice lawyer Ian Gershengorn argued that the issue is over medical care -- "not shoes ... not cars ... not broccoli" -- which everyone would need at some point. Therefore, requiring most individuals to obtain basic coverage is one way to regulate how they pay for it and also ensure that those who already are insured would not have to subsidize the health care costs for the uninsured, he said (Wall Street Journal, 12/17).

Lawyers for the states echoed Vinson's opinion, noting that the individual mandate effectively forces people to purchase a commercial product.

David Rivkin, a lawyer for the plaintiffs, said that if the government is allowed such power, the health reform law "would leave more constitutional devastation in its wake than any statute in our history" (New York Times, 12/16). If the mandate is found to be unconstitutional, the "entire [health reform law] has to fall," Florida's Deputy Attorney General Blaine Winship added (Harris/Escobedo, Bloomberg/BusinessWeek, 12/17).

According to the Times, Vinson signaled that he might become the second judge to rule the mandate unconstitutional. Vinson said that it would be "a giant leap" for the U.S. Supreme Court to agree with the administration and consider the decision to purchase health insurance an economic activity. He also appeared "somewhat more receptive" than District Court Judge Henry Hudson to the plaintiffs' plea that the entire law be invalidated (New York Times, 12/16).

On Monday, Hudson agreed with plaintiffs in a Virginia lawsuit that the individual mandate exceeds Congress' power to regulate interstate commerce. However, Hudson's ruling -- which marked the first time that a judge has struck down a central provision in the law -- did not invalidate the law or block the overhaul's implementation (California Healthline, 12/14).

Arguments on the Medicaid Expansion

Vinson appeared "less sympathetic" to the plaintiffs' argument that the overhaul's Medicaid expansion would be burdensome on states already facing financial and budgetary problems, the Washington Post reports (Washington Post, 12/16).

Beginning in 2014, the Medicaid expansion would increase the nationwide eligibility threshold for the program to 133% of the federal poverty level. The law states that the federal government will pay 100% of the cost of covering all newly eligible people through 2016 and pay 90% through 2020.

The lawsuit's plaintiffs said Congress was "pulling a bait-and-switch" on states because the law allows states to opt out of the expansion, which they say is practically impossible because of the amount of federal money they would be forfeiting (California Healthline, 12/15).

Winship argued that states now are highly dependent on federal Medicaid dollars to provide health care to low-income residents and that withdrawing from the program is unrealistic (New York Times, 12/16). States "have no real choice but to accept this new Medicaid regime," he added (Bloomberg/BusinessWeek, 12/17).

According to the Journal, Vinson appeared unconvinced and noted that at least two states in recent weeks have discussed the viability of pulling out from the program. Although Vinson did not identify the states, officials in Nevada and Texas recently have conducted such discussions. The two states are among the plaintiffs in the lawsuit (Wall Street Journal, 12/17).

Ruling To Be Issued 'as Quickly as Possible,' Vinson Says

Vinson did not indicate how or when he would issue his final ruling, only to say he would do so "as quickly as possible" (Washington Post, 12/17). Following the hearing, the plaintiffs expressed confidence that Vinson would rule in their favor, Politico reports.

McCollum said he believed that Vinson agrees with the plaintiffsâ arguments, adding, "[W]hen he said if Congress has the power to do this, to require you to buy an insurance policy in this situation because it's for everybody's benefit ... [or] make you buy broccoli and eat it so you can stay healthier because that too would help the economic conditions of other people, I think he got it" (Haberkorn, Politico, 12/16).

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